The Medical University of South Carolina decided to put in the paperwork to certify its neonatal intensive care unit, which, if approved, would be a first for the state.

Hospital leaders said at a board of trustees meeting Friday that the move comes as the S.C. Department of Health and Environmental Control added a new tier, making "Level Four" the highest designation.

Dr. Pat Cawley, CEO of MUSC Health, said care at the hospital's NICU will be no pricier and little will change if regulators approve the request. MUSC already has most of the providers it needs to fit the bill, he said. A Level 4 NICU is required to have pediatric and surgical consultants available around the clock.

The plan is another step to address South Carolina's troubling rate of infant mortality. 

In 2016, seven out of every 1,000 babies in the state died before their first birthday. That's higher than the national rate, which was 5.87 per thousand for the same year, according to a health plan that DHEC released in July.

Meanwhile, another goal is to increase the number of the very sickest babies born in hospitals that are equipped to provide them with the best care. About 82 percent of infants with very low birthweights are born in a Level 3 NICU. Regulators would like to see that increase to at least 84 percent.

Still, health officials don't want too many hospitals in the state providing overlapping services. So in South Carolina, they only allowing one hospital in a region to operate a Level 3 NICU by limiting the number to one within a 60-mile radius. 

"It is not desirable or cost-effective for all hospitals in the state to provide the higher levels of care," according to the state health plan. 

Regulators denied Trident Health's application to upgrade its nursery to a Level 3 NICU in 2014 because the existing care unit at MUSC is less than 60 miles away. Trident is fighting the decision in court.

Cawley said the state health department has begun to appreciate that some of the Level 3-designated hospitals offer a greater level of care than others.

"There are higher-level threes and lower-level threes," he told trustees.

Reach Mary Katherine Wildeman at 843-937-5594. Follow her on Twitter @mkwildeman.